title: Referral for substance abuse treatment and depression improvement among patients with co-occurring disorders seeking behavioral health services in primary care.
abstract: This study examined the relationship between substance treatment referrals and depression improvement among 2,373 participants with concurrent substance use and depressive disorders enrolled in an integrated behavioral health program. Three groups of substance treatment referral status were identified: accessed treatment (n=780), declined treatment (n=315), and no referral for treatment (n=1278). The primary outcome is improvement in depressive symptoms (PHQ-9<10 or ≥50% reduction). Using propensity score adjustments, patients accessing substance treatment were significantly more likely to achieve depression improvement than those who declined receiving treatment services (hazard ratio (HR)=1.82, 95% confidence interval (CI): 1.50-2.20, p<0.001) and those without a referral for treatment (HR=1.13, 95% CI: 1.03-1.25, p=0.014). Each 1 week delay in initiating a referral was associated with a decreased likelihood of depression improvement (HR=0.97, 95% CI: 0.96-0.98, p<0.001). Study findings highlight the need of enhancing early treatment contact for co-occurring substance use disorders in primary care.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: yfcuw@uw.edu.
authors.forename: Ya-Fen
authors.initials: YF
authors.lastname: Chan
authors.forename: Hsiang
authors.initials: H
authors.lastname: Huang
authors.forename: Katharine
authors.initials: K
authors.lastname: Bradley
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
mesh_terms: D000328:Adult; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000379:methods*; D057216:Propensity Score; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D016896:Treatment Outcome; D016312:Treatment Refusal
keywords: Depression; Integrated care; Primary care; Substance abuse treatment referral; Substance use disorder